European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study Clinical Trial Controlled Clinical Trial
Prospective, double-blind, comparative fast-tracking trial in an academic emergency department during a period of limited resources.
The aim of this study was to determine the effectiveness of 'fast-tracking' in an academic emergency department (ED) during a period of limited resources and space constraints. This was a prospective, double-blind, comparative clinical trial. Fast-tracking was applied every other day between 08.00 and 17.30 hours. ⋯ It is concluded that fast-tracking is an applicable and useful system in an academic ED with limited resources, and decreases ED length of stay and improves patient satisfaction in a selected group of patients. Determination of fast tracking criteria must be individualized for each hospital according to resources. Additionally, fast-tracking seems to be safe when performed under strict criteria for patient selection.
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To clarify the relationship between the clinical characteristics and the effects of high frequency jet ventilation based on the differences in the speed of deterioration in severe asthmatic patients who required intubation and mechanical ventilation, we classified 37 severe asthmatics into two groups (acute onset group: n = 20, intubated within 24 hours; slow onset group: n = 17, intubated over 3 days) and measured the arterial blood gas values, the duration of mechanical ventilation, and the peak inspiratory pressure during synchronized intermittent mechanical ventilation with or without high frequency jet ventilation. The acute onset group showed a significantly higher incidence of cyanosis (75% vs. 41%, p < 0.05), an acute loss of consciousness (90% vs. 53%, p < 0.05), severe mixed acidosis with extreme hypercapnoea (pH 7.11 +/- 0.19, PaCO2 94.1 +/- 10.7 mmHg, BE -8.3 +/- 1.7 mEq/l), and a more elevated peak inspiratory pressure (59.7 +/- 1.8 mmHg vs. 41.1 +/- 1.8 mmHg, p < 0.05) during synchronized intermittent mechanical ventilation at admission, compared with the slow onset group (p < 0.05). ⋯ Both the high peak inspiratory pressure and the severe mixed acidosis with markedly elevated hypercapnoea were significantly reduced by the application of high frequency jet ventilation between the intra- and the inter-groups. These findings thus indicated the existence of significant differences in the clinical features and pathogenesis of airway hyperreactivity between these two groups, and the application of high frequency jet ventilation to the status asthmaticus was thus found to be effective.
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Genital injuries may be markers of sexual abuse and child protection issues should be considered when case present. This study evaluates the quality of history taking and the physical examination of children who present with straddle injuries to an accident and emergency department. A retrospective analysis of the accident and emergency case notes of children who presented over a 12-month period with straddle injuries was undertaken. ⋯ The results showed that the documentation of injuries was inadequate in the majority of cases, increasing the risk that cases of sexual abuse may be missed. Core questions which aid in the selection of children who require further evaluation have previously been identified. Utilizing the information from our findings we have devised a protocol for the assessment of children with straddle injuries which includes an action plan for the management of such cases.
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The optimal competence level of personnel involved in prehospital emergency care is a matter for discussion. In Sweden a national quality improvement process has been initiated including strict regulation of the authorization of ambulance personnel to administer drugs and increased involvement of registered nurses. The aim of the present study was to assess from a national survey the present status of the ongoing quality improvement process in prehospital emergency care in Sweden. ⋯ The changes in the competence level and organization of the ambulance services and prehospital emergency care were considered to have had moderate (38.5%) or great (51.9%) impact on the quality of the services during the past 5 years. The effect was reported by 53.2% of the directors to be objectively verified from review of ambulance records, regular proficiency tests, patient survival data (cardiopulmonary resuscitation), and analyses of computer-based records. It is concluded that the present study clearly shows that quality improvement process initiated by the Swedish authorities has resulted in a considerable improvement of prehospital emergency care in Sweden during the past few years.